Operative Technique
The operations were performed under general anesthesia and hypothermic cardiopulmonary bypass. 145 cases underwent thoracotomy through the median incision of the chest, 10 cases were admitted to the chest through the right incisions, and 4 cases were admitted into the chest through infrasternal small incisions. If LSVC exists, we would compare the diameter of bilateral superior vena cava and block LSVC. If the LSVC pressure is greater than 16 mmHg or the left side of the neck appears cyanosis or venous engorgement, it is positive result showing that there is no communication between LSVC and right superior vena cava (RSVC), and LSVC can’t be ligated. LSVC drainage is necessary for surgeons to establish extracorporeal circulation. If the block test result is negative, the LSVC can be ligated. UCSS and LSVC and other associated intracardiac malformations will be treated simultaneously during the surgery.
Type I 76 cases: 58 cases constructed the inner tunnel(Fig 1B、C) along the posterior wall of the LA, and LSVC was drained to the CS, and the atrial septum was closed with patch around the new ostium of the CS. Four cases had no significant pressure increase of central veins or edema of head and face after obstructing the LSVC, so their LSVCs were directly ligated, and the CS was separated into the LA by the atrial septal patch. Nine cases underwent atrial septal resection, and then the large autologous pericardium (or polyester patch) were slantwise arranged in the opened left and right atrium to create a baffle, separating the LSVC to the right atrial side and the left atrial appendage, mitral valve and all pulmonary veins to the left atrial side. Three cases of direct CS reroof by pericardium. One case used bovine pericardium to make extracardiac conduit and connected LSVC and right atrial appendage and another extracardiac case underwent Glenn procedure.
Type Ⅱ 24 cases: 5 cases of atrial septal patch separated the CS into the LA and 13 cases into RA. Six cases of direct CS reroof by pericardium.
Type Ⅲ 34 cases: 16 cases were combined with LSVC, 1 of which was directly ligated. One case took extracardiac method to connect LSVC to the right atrium. Three cases of LSVC were treated by intracardiac tunnel or baffle and the rest were treated under the reroof procedures.
Type Ⅳ 25 cases: 8 cases were combined with LSVC (6 cases were drained to the CS, 2 cases to the LA), among which 3 cases were directly ligated, 2 cases were reroofed the CS, and 3 separated the CS opening to the right atrium by the atrial septal patch.
In 159 cases associated with other intracardiac malformations, 2 cases underwent palliative surgery due to complex malformations, 157 cases underwent simultaneous correction of associated malformations. All 159 patients with LSVC and intraoperative treatment are shown in Table 2.